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NOTICE OF PRIVACY PRACTICES
Effective Date -- April 16,
2002
I. This notice describes how medical
information about you may be used and disclosed
as well as how you can get access to the
information.
PLEASE REVIEW IT CAREFULLY. You should read
this Notice before signing the Consent to the
Use and Disclosure of Health Information for
Treatment, Payment and Health Care Operations.
II. Our Duty to Safeguard Your Protected
Health Information.
Individually identifiable information about
your past, present, or future health or
condition, the provision of health care to you,
or payment for the health care is considered
“Protected Health Information” (“PHI”). We are
required to extend certain protections to your
PHI, and to give you this Notice about our
privacy practices that explains how, when and
why we may use or disclose your PHI. Except in
specified circumstances, we must use or disclose
only the minimum necessary PHI to accomplish the
purpose of the use or disclosure.
We are required to follow the privacy practices
described in this Notice, though we reserve the
right to change our privacy practices and the
terms of this Notice at any time. If we do so,
we will post a new Notice in our Admissions and
Business Offices. You may request a copy of the
new notice from either the Admissions or
Business Office, and it will also be posted on
our website at
http://www.brhc.org/BRHC_Privacy.htm.
III. How We May Use and Disclose Your
Protected Health Information.
We use and disclose PHI for a variety of
reasons. For most uses/disclosures, we must
obtain your consent. For others, we must have
your written authorization. However, the law
provides that we are permitted to make some
uses/disclosures without your consent or
authorization. The following offers more
description and examples of our potential
uses/disclosures of your PHI.
• Uses
and Disclosures Relating to Treatment, Payment,
or Health Care Operations. Generally, we
must have your consent to use/disclose your PHI:
• For
treatment: We may disclose your PHI to
doctors, nurses, and other health care personnel
who are involved in providing your health care.
• To
obtain payment: We may use/disclose your PHI
in order to bill and collect payment for your
health care services.
• For
health care operations: We may use/disclose
your PHI in the course of operating our
hospital. For example, we may use your PHI in
evaluating the quality of services provided, or
disclose your PHI to our accountant or attorney
for audit purposes.
• For
appointment reminders: Unless you provide us
with alternative instructions, we may send
appointment reminders and other similar
materials to your home.
•
Exceptions: Although your consent is usually
required for the use/disclosure of your PHI for
the activities described above, the law allows
us to use/disclose your PHI without your consent
in certain situations. For example, we may
disclose your PHI if needed for emergency
treatment if it is not reasonably possible to
obtain your consent prior to the disclosure and
we think that you would give consent if able.
Also, if we are required by law to provide your
treatment, we may use/disclose your PHI for
treatment, payment and operations without
obtaining your prior consent .
• Uses and
Disclosures Requiring Authorization: For
uses and disclosures beyond treatment, payment
and operations purposes we are required to have
your written authorization, unless the use or
disclosure falls within one of the exceptions
described below. Like consents, authorizations
can be revoked at any time to stop future
uses/disclosures except to the extent that we
have already undertaken an action in reliance
upon your authorization.
• Uses
and Disclosures Not Requiring Consent or
Authorization: The law provides that we may
use/disclose your PHI without consent or
authorization in the following circumstances:
• When
required by law: We may disclose PHI when a
law requires that we report information about
suspected abuse, neglect or domestic violence,
or relating to suspected criminal activity, or
in response to a court order. We must also
disclose PHI to authorities who monitor
compliance with these privacy requirements.
• For
public health activities: We may disclose
PHI when we are required to collect information
about disease or injury, or to report vital
statistics to the public health authority
• For
health oversight activities: We may disclose
PHI to our central office, the protection and
advocacy agency, or another agency responsible
for monitoring the health care system for such
purposes as reporting or investigation of
unusual incidents.
•
Relating to decedents: We may disclose PHI
relating to an individual’s death to coroners,
medical examiners or funeral directors, and to
organ procurement organizations relating to
organ, eye, or tissue donations or transplants.
• For
research purposes: In certain circumstances,
and under supervision of a privacy board, we may
disclose PHI to our central office in order to
assist medical/psychiatric research.
• To
avert threat to health or safety: In order
to avoid a serious threat to health or safety,
we may disclose PHI as necessary to law
enforcement or other persons who can reasonably
prevent or lessen the threat of harm.
• For
specific government functions: We may
disclose PHI of military personnel and veterans
in certain situations, to correctional
facilities in certain situations, to government
programs relating to eligibility and enrollment,
and for national security reasons, such as
protection of the President.
• Uses
and Disclosures Requiring You to have an
Opportunity to Object: In the following
situations, we may disclose your PHI if we
inform you about the disclosure in advance and
you do not object. However, if there is an
emergency situation and you cannot be given your
opportunity to object, disclosure may be made if
it is consistent with any prior expressed wishes
and disclosure is determined to be in your best
interests. You must be informed and given an
opportunity to object to further disclosure as
soon as you are able to do so.
• Patient
Directories: Your name, location, general
condition, and religious affiliation may be put
into our patient directory for use by clergy and
callers or visitors who ask for you by name.
• To
families, friends or others involved in your
care: We may share with these people
information directly related to your family’s,
friend’s or other person’s involvement in your
care, or payment for your care. We may also
share PHI with these people to notify them about
your location, general condition, or death.
IV.Your Rights RegardingYour Protected
Health Information.You have the following rights
relating to your protected healthinformation:
• To request
restrictions on uses/disclosures: You have
the right to ask that we limit how we use or
disclose your PHI. BRHC will consider your
request, but we are not legally bound to agree
to any requested restriction.
• To
choose how we contact you: You have the
right to ask that we send you information at an
alternative address or by an alternative means.
We must agree to your request as long as it is
reasonably easy for us to do so.
• To
inspect and copy your PHI: Unless your
access is restricted for clear and documented
treatment reasons, you have a right to see your
protected health information if you put your
request in writing. We will respond to your
request within 30 days. If we deny your access,
we will give you written reasons for the denial
and explain any right to have the denial
reviewed. If you want copies of your PHI, a
charge for copying may be imposed, but may be
waived, depending on your circumstances. You
have a right to choose what portions of your
information you want copied and to have prior
information on the cost of copying.
• To
request amendment of your PHI: If you
believe that there is a mistake or missing
information in our record of your PHI, you may
request, in writing, that we correct or add to
the record. We will respond within 60 days of
receiving your request. We may deny the request
if we determine that the PHI is: (i) correct and
complete; (ii) not created by us and/or not part
of our records, or; (iii) not permitted to be
disclosed. Any denial will state the reasons for
denial and explain your rights to have the
request and denial, along with any statement in
response that you provide, appended to your PHI.
If we approve the request for amendment, we will
change the PHI and so inform you, and tell
others that need to know about the change in the
PHI.
• To find
out what disclosures have been made: You
have a right to get a list of when, to whom, for
what purpose, and what content of your PHI has
been released other than instances of disclosure
for which you gave consent (i.e. for treatment,
payment, operations, to you, your family, or the
facility directory). The list also will not
include any disclosures made for national
security purposes, to law enforcement officials
or correctional facilities, or before April,
2003. We will respond to your written request
for such a list within 60 days of receiving it.
Your request can relate to disclosures going as
far back as six years. There will be no charge
for up to one such list each year. There may be
a charge for more frequent requests.
• To
receive this notice: You have a right to
receive a paper copy of this Notice and/or an
electronic copy by email upon request. You can
request this at time of admission, during your
stay or anytime following your discharge from
the facility.
V. How to Complain about our Privacy
Practices:
If you think we may have violated your
privacy rights, or you disagree with a decision
we made about access to your PHI, you may file a
complaint with the person listed in Section VI.
Below. You also may file a written complaint
with the Secretary of the U.S. Department of
Health and Human Services at:
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257
Toll Free: 1-877-696-6775
http://www.hhs.gov/contacts/
We will take no retaliatory action against
you if you make such complaints.
VI. Contact Person for Information, or to
Submit a Complaint: If you have questions
about this Notice or any complaints about our
privacy practices, please contact:
Jeff McGraw
Privacy Officer
Bothwell Regional Health Center
601 East 14th
Street Sedalia, MO 65301
660-829-7591
jmcgraw@brhc.org
VII. Effective Date: This Notice was
effective on April 16, 2002.
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